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射频消融联合经动脉化疗栓塞治疗肝细胞癌的Meta分析

Meta-analysis on radiofrequency ablation in combination with transarterial chemoembolization for the treatment of hepatocellular carcinoma.

作者信息

Cao Jiang-Hui, Zhou Jun, Zhang Xiao-Long, Ding Xun, Long Qing-Yun

机构信息

Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.

出版信息

J Huazhong Univ Sci Technolog Med Sci. 2014 Oct;34(5):692-700. doi: 10.1007/s11596-014-1338-5. Epub 2014 Oct 16.

Abstract

To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and TACE alone for hepatocellular carcinoma (HCC), Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Datebases were searched for the randomized controlled trials (RCTs) and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were undertaken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously associated with higher 1-, 2-, and 3-year overall survival rates (OR1-year=3.98, 95% CI 2.87-5.51, P<0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P<0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P<0.00001) than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone (OR=13.86, 95% CI 8.04-23.89, P<0.00001). And there was a significant difference in local recurrence rate between two different kinds of treatment (OR=0.24, 95%CI 0.14-0.44, P<0.00001). Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy. TACE-plus-RFA treatment was associated with a higher response rate (RR) than the TACE-alone treatment (OR=3.90, 95% CI=2.37-6.42, P<0.00001). TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease (SD) rate (OR=0.38, 95% CI=0.11-1.26, P=0.11). Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease (PD) rate (OR=0.15, 95% CI=0.05-0.43, P=0.0005). The rate of AFP reducing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group (OR=4.62, 95% CI 2.56-8.34, P<0.00001). The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients' overall survival rate, tumor necrosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.

摘要

为评估经动脉化疗栓塞术(TACE)联合射频消融术(RFA)与单纯TACE治疗肝细胞癌(HCC)的疗效和安全性,检索了PubMed、Cochrane图书馆、科学网、中国知网和万方数据库,查找从数据库建立至2014年1月的随机对照试验(RCT)和回顾性队列研究。还检索了纳入研究的参考文献。在进行研究选择、评估、数据收集和分析后,我们使用RevMan5.2软件进行了这项荟萃分析。17项涉及1116例患者的研究符合纳入标准,其中530例接受RFA加TACE治疗,586例仅接受TACE治疗。荟萃分析结果显示,与单纯TACE相比,TACE联合RFA明显与更高的1年、2年和3年总生存率相关(OR1年 = 3.98,95%CI 2.87 - 5.51,P < 0.00001;OR2年 = 3.03,95%CI 2.10 - 4.38,P < 0.00001;OR3年 = 7.02,95%CI 4.14 - 11.92,P < 0.00001)。接受TACE联合RFA治疗的患者肿瘤完全坏死率高于单纯TACE治疗(OR = 13.86,95%CI 8.04 - 23.89,P < 0.00001)。两种不同治疗方法的局部复发率存在显著差异(OR = 0.24,95%CI 0.14 - 0.44,P < 0.00001)。此外,在肝癌治疗中,TACE联合RFA与更高的肿瘤完全坏死率相关。然而,发现RFA加TACE与比单纯TACE更低的局部复发率相关。TACE加RFA治疗的缓解率(RR)高于单纯TACE治疗(OR = 3.90,95%CI = 2.37 - 6.42,P < 0.00001)。TACE加RFA治疗与单纯TACE治疗在疾病稳定(SD)率方面无差异(OR = 0.38,95%CI = 0.11 - 1.26,P = 0.11)。荟萃分析表明,RFA与TACE联合与显著更低的疾病进展(PD)率相关(OR = 0.15,95%CI = 0.05 - 0.43,P = 0.0005)。RFA加TACE组血清中AFP降低或恢复正常的比率明显低于单纯TACE组(OR = 4.62,95%CI 2.56 - 8.34,P < 0.00001)。TACE联合RFA治疗肝癌的效果优于单纯TACE治疗。与单纯TACE相比,联合治疗可提高患者的总生存率、肿瘤坏死率以及血清中AFP降低或恢复正常的比率,并降低局部复发率和PD率。

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